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Swine flu is hitting First Nations in Manitoba harder, province's top doc says

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TORONTO - Manitoba's top doctor says it does appear that swine flu is hitting First Nations people in the province harder than non-aboriginal Manitobans.

Dr. Joel Kettner said numbers of cases are still small and analyses have to be treated with caution, but the impression created by the number of medical evacuations from remote northern communities seems to reflect a real situation.

"It appears from our information that . . . (among) our most severe cases, there's an over-representation from a population and demographic perspective, of First Nations and aboriginal people," Kettner, the chief medical officer of health, said Monday in an interview from Winnipeg.

He said his staff have been analyzing hospital admissions and other types of data to see who is getting sick and who among them is getting most severely ill.

Epidemiological information like that is critical for public health officials trying to tailor advice on reducing risk of exposure. As well, authorities will need to know who is at highest risk so that they can revise priority lists for pandemic vaccine when it becomes available.

Kettner said two-thirds of 24 Manitobans in intensive care units fighting swine flu last week were First Nations people. Given that aboriginal peoples make up only 10 to 15 per cent of the population of the province, that seems an unduly large proportion, he said.

The average age of those in this ICU cohort was 35 years old - an unusually young age for people to need ICU care for flu.

"We're seeing very few people in intensive care older than 55," said Kettner. "And we're seeing very few infants, or under two (years of age)."

Chief David McDougall's northern Manitoba community of St. Theresa Point has had 27 people transported south for treatment of swine flu. Some of the people who have become severely ill aren't among those one would typically expect to see hospitalized for flu, he said.

"I know some of the people. And some people were in relatively good health," McDougall said.

Two were pregnant women. One miscarried, the other had to have her baby delivered by caesarean section.

Chief Adam Fiddler from the Sandy Lake First Nations community in Northwestern Ontario said medical evacuations from his community have risen in the past few days. So far the community has sent out about 10 people to Winnipeg for care. Some have already returned.

(Sandy Lake, which is near the Manitoba border, is 450 kilometres from Winnipeg, but 600 kilometres north of Thunder Bay, the nearest large Ontario city.)

A problem Sandy Lake is starting to see is secondary health problems setting in for people recovering from the flu, Fiddler said.

The cases, still few in number, may be pneumonia, he suggested, adding people are being urged to seek care if they seem to be regressing after recovery. One of the recent evacuees had earlier recovered from H1N1 flu, he said.

Kettner acknowledged that epidemiologists might argue that the relative high numbers of First Nations people in Manitoba's ICUs may reflect the fact that more aboriginal people have been infected to date.

"It could be that crowded housing conditions and small communities promote faster spread and faster exposure," he said, adding that while he is open to that explanation, he doesn't believe it accounts for the whole story.

Kettner travelled to St. Theresa Point last Friday with Manitoba Health Minister Theresa Oswald.

He said his staff are at work trying to tease out more details of what is going on. He said they are conducting a very detailed epidemiological analysis of all respiratory infections in at least one community and maybe more. He would not name the community or say whether it is a First Nations reserve.

"We're going to try to paint a very full picture of this," he said, adding he expects to have some data from that work in the next few days.

Kettner said figuring out whether First Nations people are being disproportionately harder hit is a necessary part of understanding swine flu.

"It may be an important indicator, not only of understanding the disease with respect to who gets most severely ill, but also it's just a marker to say 'Well, if that's the truth, whatever the reason is, people who are aboriginal or people ... looking after people who are aboriginal should be aware of that fact,"' he said.

The findings might guide how care is prioritized, he added.

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Follow Canadian Press Medical Writer Helen Branswell's flu updates on Twitter at CP-Branswell

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